Reference | Definition of failed noninvasive ventilation | Participants | Interventions | Outcomes | Factors pertaining to the quality of studies |
---|---|---|---|---|---|
[15] | GCS score ≤13, persistent severe respiratory distress, Po2 <60 mmHg despite oxygen supplementation, an increase in PaCO2 >5 mmHg | 56 patients (recruited between January 1999 and August 2000), mean APACHE II score 19.5, mean age 64 years, mean PaCO2 at presentation 40 mmHg | Variable CPAP (10–16 cmH2O), variable BiPAP (starting from 15 and 10 cmH2O; maximum not described) | Proportion of patients with hospital mortality and requiring intubation, the duration of noninvasive ventilation needed and hospital length of stay | Allocation concealment adequate; study not blinded; 3.6% of patients did not have pulmonary oedema were excluded from analysis; analysis was by intention to treat; Jadad scale score 3 |
[9] | Severe respiratory distress, inability to tolerate or synchronize with the mask, further deterioration in vital signs or significant haemodynamic compromise, Po2 <60 mmHg despite oxygen supplementation, an increase in PaCO2 >5 mmHg | 36 patients, mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 50 mmHg | Fixed CPAP (10 cmH2O), fixed BiPAP (15 and 5 cmH2O) | Proportion of patients with hospital mortality and requiring intubation, new onset acute myocardial infarction, duration of noninvasive ventilation needed and hospital length of stay | Allocation concealment not clear; double blinding; 22% of enrolled patients did not have pulmonary oedema and were excluded from analysis, and 2.8% were excluded because of delay in starting CPAP; analysis was not by intention to treat; Jadad scale score 5 |
[14] | Intubation determined by the attending physician but criteria were not described | 16 patients (recruited between May and October 1997), mean APACHE II score not available, mean age 69 years, mean PaCO2 at presentation 40 mmHg | Variable CPAP (5–12.5 cmH2O), variable BiPAP (starting from 8 and 3 cmH2O; maximum not described) | Proportion of patients with hospital mortality and requiring intubation, duration of noninvasive ventilation needed | Allocation concealment not clear; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 2 |
[16] | Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg, and the clinician could elect to intubate if they felt that the patient's condition was not improving satisfactorily | 71 patients, mean APACHE II score not available, mean age 74 years, mean PaCO2 at presentation not available | Variable CPAP (5–20 cmH2O), variable BiPAP (starting from 10 and 5 cmH2O; maximum 20 and 5) | Proportion of patients with hospital mortality and requiring intubation, the duration of noninvasive ventilation needed and hospital length of stay | Allocation concealment not clear; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 2 |
[18] | Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg | 46 patients (recruited between March 2002 and March 2003), mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 54 mmHg | Fixed CPAP (10 cmH2O), variable BiPAP (starting with 15 and 5 cmH2O; titration of inspiratory pressure to achieve tidal volume >400 ml) | Proportion of patients with hospital mortality and requiring intubation, new onset acute myocardial infarction, duration of noninvasive ventilation needed | Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |
[17] | Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg | 36 patients (recruited between January 2001 and January 2002), mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 63 mmHg | Fixed CPAP (10 cmH2O), variable BiPAP (starting with 15 and 5 cmH2O; titration of inspiratory pressure to achieve tidal volume >400 ml) | Proportion of patients with hospital mortality and requiring intubation, duration of noninvasive ventilation needed | Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |
[19] | Worsening clinical signs (respiratory rate >40 or <10 breaths/minute, reduced conscious level) associated with a falling arterial pH (less than at arrival and <7.2) | 40 patients, mean APACHE II score not available, mean age 75 years, mean PaCO2 at presentation 62 mmHg | Fixed CPAP (10 cmH2O), fixed BiPAP (15 and 5 cmH2O) | Proportion of patients with hospital mortality and requiring intubation, new onset myocardial infarction | Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |